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Vermont
Ethics Network
Physician
Assisted Suicide …. Some Definitions
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For
a discussion of “Physician-assisted suicide” – Some
Definitions
(supplied by Dr. Arnold Golodetz
for VEN Annual Meeting discussion 10/14/03.)
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| Physician-assisted
suicide (PAS) |
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| A
suicide facilitated by a physician’s
action(s), usually by the provision of a prescription for a
potentially lethal drug, knowing that the patient might use
that drug at some future time to end his life. The physician
does not participate in the actual administration of the drug. |
| Physician aid-in-dying
(PAD) |
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| An
alternative term used by persons who claim that in the situation
of terminally ill persons “suicide” is
an inappropriate term. However, the term could be used to conflate
PAS with every other way in which physicians seek to ease the
process of dying, such as Palliative Care. |
| Euthanasia |
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Euthanasia: Literally means “a
good death” (a peaceful or “tame” death).
The word itself does not specify how that is to be achieved. “ Euthanasia” in
common usage means ending someone’s life with merciful
intent, to relieve expressed or perceived suffering. In a
more extreme sense, it means extinguishing “life not
worthy to be lived”, on a political and ideologic basis – the “Nazi” sense.
In
the medical context, euthanasia means – a direct
action taken by a physician with the primary intent of
ending life. The paradigmatic case would be the injection
of a substance that would immediately stop heart action.
Two forms are:
- Voluntary
euthanasia – undertaken at the explicit,
concurrent request of a competent patient.
- Non-voluntary
euthanasia – undertaken pursuant
to advance directive or surrogate decision, the patient
no longer being competent.
[ “Involuntary” euthanasia means the ending
of life without either patient or surrogate decision,
usually for social policy purposes,
as in Nazi Germany.]
Voluntary and non-voluntary euthanasia is illegal everywhere in the
United States and almost everywhere else.
Note that, given these definitions, the proposed VT law
does NOT license euthanasia
The term “active euthanasia” covers the above meanings. One
sometimes hears the term “passive euthanasia” applied to
the discontinuance of life-support at the patient’s request, but
that is a misnomer, since it is not the direct, intentional ending of
life.
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| Right to Die |
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| The
popular use of the term implies that one has a right to determine
the time and manner of one’s
death, but it is not clear where the “right” comes
from. There is no such thing explicit in any form of U.S. law.
However, proponents claim a basis in “natural law”,
invoking concepts of “liberty”, “autonomy” and “privacy”.
Given this way of thinking, the question remains “Is
this right a negative right, meaning one should be left alone
to end one’s own life, or a positive right, meaning an
there is an obligation on society to provide the help needed
for directly ending life?”. And if there is such a positive
right, can society limit it to the terminally ill, or can it
be invoked by anyone who is tired of life? |
| Right to Refuse Treatment |
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| Right
to Refuse Treatment: In contrast, there is a firmly established
right under the U.S.
Constitution that a competent adult can refuse any offer of
medical treatment for his own reasons (with rare exceptions),
and not just in “terminal” situations. And it is
almost as clear that this right can be exercised via advance
directives. (But note that in the non-terminal situation, there
would often be reason for doubting “competence” and
thus for the exercise of “weak paternalism” on
the part of family and attendant physicians.) |
| “ Death
With Dignity” |
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| Proponents
of laws permitting PAS use this label, suggesting that dignity
resides in having
and using a “right to die”. |
| Palliative Care (PC) |
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Palliative
Care (PC): The literal meaning in the medical context is “Care whose primary
purpose is the relief of suffering”. As such, PC has
a place in the care of almost any medical problem, at any stage
of life, and is generally referred to as symptom-relief.
However, given a situation in which the preservation of life
is no longer a goal and relief of suffering is the predominant
goal (“Palliative
Care Only” or “Comfort Care Only”), PC becomes what can
be called the comprehensive care of the dying, usually by a specially skilled
multidisciplinary team, most often in hospice. |
Some
Legal Points - Vermont has no statutory law forbidding
suicide or assistance in suicide. (Some states do). However,
the Attorney-General has some discretionary capability
under common law for bringing an action against a physician
who assists in suicide. Also, the physician is at some
risk of federal action under the Controlled Substances
Act. A clear act of euthanasia would classify as homicide.
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